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The Swiss psychiatrist Hermann Rorschach developed a set of inkblots to test subjects in his clinical research. In a 1921 monograph (published in English in 1942 and 1951), Rorschach postulated that the blots evoke consistent and similar responses in groups patients. Only ten of the original inkblots are currently in diagnostic use. It was John Exner who systematized the administration and scoring of the test, combining the best of several systems in use at the time (e.g., Beck, Kloper, Rapaport, Singer).
The Rorschach inkblots are ambiguous forms, printed on 18X24 cm. cards, in both black and white and color. Their very ambiguity provokes free associations in the test subject. The diagnostician stimulates the formation of these flights of fantasy by asking questions such as "What is this? What might this be?". S/he then proceed to record, verbatim, the patient's responses as well as the inkblot's spatial position and orientation. An example of such record would read: "Card V upside down, child sitting on a porch and crying, waiting for his mother to return."
Having gone through the entire deck, the examiner than proceeds to read aloud the responses while asking the patient to explain, in each and every case, why s/he chose to interpret the card the way s/he did. "What in card V prompted you to think of an abandoned child?". At this phase, the patient is allowed to add details and expand upon his or her original answer. Again, everything is noted and the subject is asked to explain what is the card or in his previous response gave birth to the added details.
Scoring the Rorschach test is a demanding task. Inevitably, due to its "literary" nature, there is no uniform, automated scoring system.
Methodologically, the scorer notes four items for each card:
I. Location - Which parts of the inkblot were singled out or emphasized in the subject's responses. Did the patient refer to the whole blot, a detail (if so, was it a common or an unusual detail), or the white space.
II. Determinant - Does the blot resemble what the patient saw in it? Which parts of the blot correspond to the subject's visual fantasy and narrative? Is it the blot's form, movement, color, texture, dimensionality, shading, or symmetrical pairing?
III. Content - Which of Exner's 27 content categories was selected by the patient (human figure, animal detail, blood, fire, sex, X-ray, and so on)?
IV. Popularity - The patient's responses are compared to the overall distribution of answers among people tested hitherto. Statistically, certain cards are linked to specific images and plots. For example: card I often provokes associations of bats or butterflies. The sixth most popular response to card IV is "animal skin or human figure dressed in fur" and so on.
V. Organizational Activity - How coherent and organized is the patient's narrative and how well does s/he link the various images together?
VI. Form Quality - How well does the patient's "percept" fit with the blot? There are four grades from superior (+) through ordinary (0) and weak (w) to minus (-). Exner defined minus as:
"(T)he distorted, arbitrary, unrealistic use of form as related to the content offered, where an answer is imposed on the blot area with total, or near total, disregard for the structure of the area."
The interpretation of the test relies on both the scores obtained and on what we know about mental health disorders. The test teaches the skilled diagnostician how the subject processes information and what is the structure and content of his internal world. These provide meaningful insights into the patient's defenses, reality test, intelligence, fantasy life, and psychosexual make-up.
Still, the Rorschach test is highly subjective and depends inordinately on the skills and training of the diagnostician. It, therefore, cannot be used to reliably diagnose patients. It merely draws attention to the patients' defenses and personal style.
(From the book "Malignant Self-love: Narcissism Revisited" by Sam Vaknin - Click on this link to purchase the print book, or 16 e-books, or 3 DVDs with 16 hours of video lectures on narcissists, psychopaths, and abuse in relationships: http://www.narcissistic-abuse.com/thebook.html)